Provider Demographics
NPI:1558449363
Name:DEGAMO, TERESITA YEE (MD)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:YEE
Last Name:DEGAMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-3354
Mailing Address - Country:US
Mailing Address - Phone:415-391-9686
Mailing Address - Fax:415-433-4726
Practice Address - Street 1:211 EASTMOOR AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2036
Practice Address - Country:US
Practice Address - Phone:650-550-3923
Practice Address - Fax:650-756-3472
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50610207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558449363Medicaid
CAAT475AOtherMEDICARE PTAN